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Submitted URL:
http://lungaction.org//
Effective URL:
https://www.lung.org/policy-advocacy/take-action/lung-action-network
Submission: On August 01 via api (August 1st 2024, 2:57:36 am UTC) from US — Scanned from DE

Form analysis
6 forms found in the DOM

<form class="search-form js-search-form">
  <div class="input-group"><label for="header-search" class="sr-only">Search</label>
    <div class="typeahead typeahead__open">
      <div class="typeahead__toggle"><input type="text" title="Search Text Input" placeholder="Search" class="typeahead__search" data-uw-rm-form="fx" aria-label="Search"> <span class="typeahead__text"
          style="visibility: hidden; display: none;"></span> <span class="input-group-append"><button aria-label="Search" type="button" class="btn btn-secondary typeahead__button desktop-only"><span class="icon-search"></span></button></span></div>
      <!---->
    </div>
  </div>
</form>

Name: findrepcomponent — POST https://action.lung.org/site/FindRepresentatives

<form action="https://action.lung.org/site/FindRepresentatives" id="findrepcomponent" method="post" name="findrepcomponent">
  <div id="byZip"><input name="NEXTURL" type="hidden" value="https%3A%2F%2Faction.lung.org%2Fsite%2FSPageNavigator%2FelectedOfficials.html"> <input name="orig_zip" type="hidden" value=""> <label for="zip" style="white-space: normal">Enter your 5
      digit ZIP code or your
      <a href="https://www.usps.com/zip4/" target="_blank" title="Open a new window to the US Post Office to look up your ZIP+4" data-uw-rm-brl="PR" data-uw-original-href="https://www.usps.com/zip4/" aria-label="ZIP+4 - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.usps.com/zip4/$zip+4">ZIP+4</a>:&nbsp;</label>
    <span><input id="zip" maxlength="10" name="zip" size="10" type="text" value="Enter ZIP" data-uw-rm-form="nfx"> <input class="Button button red" id="go" name="go" type="submit" value="GO" data-uw-rm-form="fx" aria-label="Submit button"
        data-uw-hidden-control="hidden-control-element"></span></div>
</form>

POST /Kentico.Components/en-US/Kentico.FormWidget/KenticoFormWidget/FormSubmit?formName=LungActionNetwork&prefix=form-LungActionNetwork-2257&displayValidationErrors=False

<form action="/Kentico.Components/en-US/Kentico.FormWidget/KenticoFormWidget/FormSubmit?formName=LungActionNetwork&amp;prefix=form-LungActionNetwork-2257&amp;displayValidationErrors=False"
  data-ktc-ajax-update="form-LungActionNetwork-2257_wrapper-28c37794-a5f3-4467-9473-c1f291cbf183" id="form-LungActionNetwork-2257" method="post" onsubmit="window.kentico.updatableFormHelper.submitForm(event);" novalidate="novalidate">
  <div class="ktc-default-section">
    <div class="form-field">
      <label class="control-label" for="form-LungActionNetwork-2257_Title_Value">Title</label>
      <div class="editing-form-control-nested-control">
        <div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker mobile-device" data-ktc-notobserved-element="" id="dropdownComponent-bssmt5r3jbz" name="form-LungActionNetwork-2257.Title.Value"
            title="Please Select" tabindex="-98" data-uw-rm-form="fx" aria-label="Please Select" data-uw-hidden-control="hidden-control-element">
            <option class="bs-title-option" value=""></option>
            <option value="---">---</option>
            <option value="Mr.">Mr.</option>
            <option value="Ms.">Ms.</option>
            <option value="Mrs.">Mrs.</option>
            <option value="Miss">Miss</option>
            <option value="Dr.">Dr.</option>
            <option value="Mr. &amp; Mrs.">Mr. &amp; Mrs.</option>
          </select><button type="button" class="btn dropdown-toggle btn-light bs-placeholder" data-toggle="dropdown" role="combobox" aria-owns="bs-select-1" aria-haspopup="listbox" aria-expanded="false" data-id="dropdownComponent-bssmt5r3jbz"
            title="Please Select">
            <div class="filter-option">
              <div class="filter-option-inner">
                <div class="filter-option-inner-inner">Please Select</div>
              </div>
            </div>
          </button>
          <div class="dropdown-menu ">
            <div class="inner show" role="listbox" id="bs-select-1" tabindex="-1">
              <ul class="dropdown-menu inner show" role="presentation"></ul>
            </div>
          </div>
        </div>
        <div class="error empty hidden"> Please select an option above </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.selectRefresh("#dropdownComponent-bssmt5r3jbz");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.selectRefresh("#dropdownComponent-bssmt5r3jbz");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Title.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Title" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_FirstName_Value">First Name</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input  required" data-ktc-notobserved-element="" data-validate-id="textComponent-fftbrs4j1ww" id="form-LungActionNetwork-2257_FirstName_Value"
          name="form-LungActionNetwork-2257.FirstName.Value" type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-fftbrs4j1ww']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-fftbrs4j1ww']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.FirstName.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.FirstName" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_LastName_Value">Last Name</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input  required" data-ktc-notobserved-element="" data-validate-id="textComponent-t5wnkybk3rk" id="form-LungActionNetwork-2257_LastName_Value"
          name="form-LungActionNetwork-2257.LastName.Value" type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-t5wnkybk3rk']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-t5wnkybk3rk']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.LastName.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.LastName" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_Email_Email">Email</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control" data-ktc-notobserved-element="" id="form-LungActionNetwork-2257_Email_Email" name="form-LungActionNetwork-2257.Email.Email" placeholder="myname@email.com" type="email" value=""
          data-uw-rm-form="nfx">
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Email.Email" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Email" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_Street1_Value">Street 1</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input  required" data-ktc-notobserved-element="" data-validate-id="textComponent-gn42ux1kifl" id="form-LungActionNetwork-2257_Street1_Value" name="form-LungActionNetwork-2257.Street1.Value"
          type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-gn42ux1kifl']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-gn42ux1kifl']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Street1.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Street1" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label" for="form-LungActionNetwork-2257_Street2_Value">Street 2</label>
      <div class="editing-form-control-nested-control">
        <input class="form-control text-input " data-ktc-notobserved-element="" data-validate-id="textComponent-ovyd32z3e4q" id="form-LungActionNetwork-2257_Street2_Value" name="form-LungActionNetwork-2257.Street2.Value" type="text" value=""
          data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-ovyd32z3e4q']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-ovyd32z3e4q']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Street2.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Street2" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_City_Value">City</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input  required" data-ktc-notobserved-element="" data-validate-id="textComponent-nusmagcz135" id="form-LungActionNetwork-2257_City_Value" name="form-LungActionNetwork-2257.City.Value"
          type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-nusmagcz135']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-nusmagcz135']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.City.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.City" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_State_Value">State</label>
      <div class="editing-form-control-nested-control">
        <div class="">
          <div class="dropdown bootstrap-select"><select data-ktc-notobserved-element="" data-live-search="true" id="dropdownComponent-dxe3dm0fcj5" name="form-LungActionNetwork-2257.State.Value" class="mobile-device" tabindex="-98"
              data-uw-rm-form="fx" aria-label="Single select" data-uw-hidden-control="hidden-control-element">
              <option value="">Please Select</option>
              <option value="AL">Alabama</option>
              <option value="AK">Alaska</option>
              <option value="AZ">Arizona</option>
              <option value="AR">Arkansas</option>
              <option value="CA">California</option>
              <option value="CO">Colorado</option>
              <option value="CT">Connecticut</option>
              <option value="DE">Delaware</option>
              <option value="DC">District of Columbia</option>
              <option value="FL">Florida</option>
              <option value="GA">Georgia</option>
              <option value="HI">Hawaii</option>
              <option value="ID">Idaho</option>
              <option value="IL">Illinois</option>
              <option value="IN">Indiana</option>
              <option value="IA">Iowa</option>
              <option value="KS">Kansas</option>
              <option value="KY">Kentucky</option>
              <option value="LA">Louisiana</option>
              <option value="ME">Maine</option>
              <option value="MD">Maryland</option>
              <option value="MA">Massachusetts</option>
              <option value="MI">Michigan</option>
              <option value="MN">Minnesota</option>
              <option value="MS">Mississippi</option>
              <option value="MO">Missouri</option>
              <option value="MT">Montana</option>
              <option value="NE">Nebraska</option>
              <option value="NV">Nevada</option>
              <option value="NH">New Hampshire</option>
              <option value="NJ">New Jersey</option>
              <option value="NM">New Mexico</option>
              <option value="NY">New York</option>
              <option value="NC">North Carolina</option>
              <option value="ND">North Dakota</option>
              <option value="OH">Ohio</option>
              <option value="OK">Oklahoma</option>
              <option value="OR">Oregon</option>
              <option value="PA">Pennsylvania</option>
              <option value="PR">Puerto Rico</option>
              <option value="RI">Rhode Island</option>
              <option value="SC">South Carolina</option>
              <option value="SD">South Dakota</option>
              <option value="TN">Tennessee</option>
              <option value="TX">Texas</option>
              <option value="UT">Utah</option>
              <option value="VT">Vermont</option>
              <option value="VA">Virginia</option>
              <option value="WA">Washington</option>
              <option value="WV">West Virginia</option>
              <option value="WI">Wisconsin</option>
              <option value="WY">Wyoming</option>
            </select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-2" aria-haspopup="listbox" aria-expanded="false" data-id="dropdownComponent-dxe3dm0fcj5"
              title="Please Select">
              <div class="filter-option">
                <div class="filter-option-inner">
                  <div class="filter-option-inner-inner">Please Select</div>
                </div>
              </div>
            </button>
            <div class="dropdown-menu ">
              <div class="bs-searchbox"><input type="search" class="form-control" autocomplete="off" role="combobox" aria-label="Search" aria-controls="bs-select-2" aria-autocomplete="list" data-uw-rm-form="nfx"></div>
              <div class="inner show" role="listbox" id="bs-select-2" tabindex="-1">
                <ul class="dropdown-menu inner show" role="presentation"></ul>
              </div>
            </div>
          </div>
        </div>
        <div class="error hidden"> Please select an option above </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.selectRefresh("#dropdownComponent-dxe3dm0fcj5");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.selectRefresh("#dropdownComponent-dxe3dm0fcj5");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.State.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.State" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_ZipCode_Value">ZIP</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input zipcode required" data-ktc-notobserved-element="" data-validate-id="textComponent-gz5gutlm5mb" id="form-LungActionNetwork-2257_ZipCode_Value"
          name="form-LungActionNetwork-2257.ZipCode.Value" type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-gz5gutlm5mb']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-gz5gutlm5mb']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.ZipCode.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.ZipCode" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label required required-field-red-star" for="form-LungActionNetwork-2257_Country_Value">Country</label>
      <div class="editing-form-control-nested-control">
        <input aria-required="true" class="form-control text-input  required" data-ktc-notobserved-element="" data-validate-id="textComponent-zxz3vbfkke4" id="form-LungActionNetwork-2257_Country_Value" name="form-LungActionNetwork-2257.Country.Value"
          type="text" value="" data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-zxz3vbfkke4']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-zxz3vbfkke4']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Country.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Country" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label" for="form-LungActionNetwork-2257_Phone_Value">Phone</label>
      <div class="editing-form-control-nested-control">
        <input class="form-control text-input phone" data-ktc-notobserved-element="" data-validate-id="textComponent-mamuhep04bk" id="form-LungActionNetwork-2257_Phone_Value" name="form-LungActionNetwork-2257.Phone.Value" type="text" value=""
          data-uw-rm-form="nfx">
        <div class="error empty hidden"> Please complete the field above </div>
        <div class="error email hidden"> Please enter a valid email </div>
        <div class="error emailplus hidden"> Email address cannot contain '+' symbols </div>
        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
          if (document.readyState === "loading") {
            // Calls the function during the 'DOMContentLoaded' event, after the HTML document has been completely loaded
            document.addEventListener("DOMContentLoaded", function() {
              if (window.FormTools == null) return;
              FormTools.setDynamic("input[data-validate-id='textComponent-mamuhep04bk']");
            });
          } else if (window.FormTools != null) {
            // Calls the function directly in cases where the widget is rendered dynamically after 'DOMContentLoaded' has occurred
            FormTools.setDynamic("input[data-validate-id='textComponent-mamuhep04bk']");
          }
        </script>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Phone.Value" data-valmsg-replace="true"></div>
        <div class="field-validation-valid" data-valmsg-for="form-LungActionNetwork-2257.Phone" data-valmsg-replace="true"></div>
      </div>
    </div>
    <div class="form-field">
      <label class="control-label" for="form-LungActionNetwork-2257_Employer_Value">Employer</label>
      <div class="editing-form-control-nested-control">
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        <div class="error email hidden"> Please enter a valid email </div>
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        <div class="error phone hidden"> Please enter a valid phone number </div>
        <div class="error zipcode hidden"> Please enter your zipcode in ##### or #####-#### format </div>
        <script type="text/javascript">
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            <option value="Accounting">Accounting</option>
            <option value="Administrative, Support, and Clerical">Administrative, Support, and Clerical</option>
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            <option value="Aerospace and Defense">Aerospace and Defense</option>
            <option value="Agriculture, Forestry, and Fishing">Agriculture, Forestry, and Fishing</option>
            <option value="Architecture">Architecture</option>
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            <option value="Property Management">Property Management</option>
            <option value="Psychology">Psychology</option>
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            <option value="Sales">Sales</option>
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            <option value="Student">Student</option>
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        <div class="error empty hidden"> Please select an option above </div>
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</form>

Name: responsiveSurvey — POST https://action.lung.org/site/SSurvey

<form action="https://action.lung.org/site/SSurvey" id="responsiveSurvey-modal" method="post" name="responsiveSurvey" target="redirectframe">
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